Nausea during surgery?

[menaniac]

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I'm going to be starting med school in the fall, and am very interested in surgery, but today had a very odd experience that has me a bit wigged out. My husband was diagnosed with basal cell carcinoma last week, and had to go in to have the tissue surrounding the tumor excised today. Like the psycho med-student-to-be I was really psyched to go and watch the procedure to see what it was like (not that I was expecting that much excitement, the tumor was pretty small). Once in the exam room, the dermatologist prepped him while I stood there watching and holding his hand. The scalpel came out and started cutting, and I was watching and asking questions when all of a sudden I felt nautious, started sweating and eventually had to sit down before I passed out right there on the floor! How embarassing! The weird thing is, I wasn't emotionally stressed about this, had been looking forward to watching, and was intellectually involved in the procedure, but I felt like my physical body had mutanied and was just going to have none of that! This is something that I totally wasn't expecting! Yes, this is the first time I'd actually watched a surgical procedure being done (as small as it was), but its not the first time I've been around cuts, copious amounts of blood, and other sundry medical unpleasantness, even with someone I'm close to.

I guess my question is: has this happened to other people who are experiencing surgery for the first time? If so, how do you get over it? Is it an exposure/desensitization issue? I'll tell you, its not simply a mind over matter thing...my mind was working just fine, was telling my body to relax and be good, but my body was just not going to behave no matter what I told it, until I removed it from the situation. Am I going to have to give up surgery as a potential life-path simply because my parasympathetic nervous system won't behave? Somebody give me some hope here!

 

[Haemulon]

I'm going to be starting med school in the fall, and am very interested in surgery, but today had a very odd experience that has me a bit wigged out. My husband was diagnosed with basal cell carcinoma last week, and had to go in to have the tissue surrounding the tumor excised today. Like the psycho med-student-to-be I was really psyched to go and watch the procedure to see what it was like (not that I was expecting that much excitement, the tumor was pretty small). Once in the exam room, the dermatologist prepped him while I stood there watching and holding his hand. The scalpel came out and started cutting, and I was watching and asking questions when all of a sudden I felt nautious, started sweating and eventually had to sit down before I passed out right there on the floor! How embarassing! The weird thing is, I wasn't emotionally stressed about this, had been looking forward to watching, and was intellectually involved in the procedure, but I felt like my physical body had mutanied and was just going to have none of that! This is something that I totally wasn't expecting! Yes, this is the first time I'd actually watched a surgical procedure being done (as small as it was), but its not the first time I've been around cuts, copious amounts of blood, and other sundry medical unpleasantness, even with someone I'm close to.

I guess my question is: has this happened to other people who are experiencing surgery for the first time? If so, how do you get over it? Is it an exposure/desensitization issue? I'll tell you, its not simply a mind over matter thing...my mind was working just fine, was telling my body to relax and be good, but my body was just not going to behave no matter what I told it, until I removed it from the situation. Am I going to have to give up surgery as a potential life-path simply because my parasympathetic nervous system won't behave? Somebody give me some hope here!

I have nothing to offer as knowledge or advice about this, but I can say that I share your concern. I have never watched a serious operation up close and have no idea how I would react. Like you, it doesn't bother me or stress me in the least to think about, but you never know until you get there I suppose. Of course, I did watch a vaginal delivery up close for my first child (wow, how in the world did she fit through there??) and went in with my wife for her c-section this last time. None of that bothered me, but I was focused on other things at the time. So who knows.

 

[sunnyjohn]

...
I guess my question is: has this happened to other people who are experiencing surgery for the first time? If so, how do you get over it? Is it an exposure/desensitization issue? I'll tell you, its not simply a mind over matter thing...my mind was working just fine, was telling my body to relax and be good, but my body was just not going to behave no matter what I told it, until I removed it from the situation. Am I going to have to give up surgery as a potential life-path simply because my parasympathetic nervous system won't behave? Somebody give me some hope here!

I'm a CST (surgical technologist). I've been scrubbing/first assisting for years and not to toot my own horn, but I'm VERY good at my job.

Every now and then I will get quesy, especially if they turn the bovie up reeeeeeeal high and the smell of charred flesh hits me.

Naw, your career in surgery is not over. I would be rich if I had a dime for every med student, resident, nursing student and OR visitor I've seen almost hit the floor.

 

[Tired]

Personally, I never had any issues with this. My problem was always over-heating in the gown + mask + face shield, but there are ways to deal with that.

The conventional wisdom seems to be that passing out your first couple times in surgery is not uncommon. When I was on surgery, I had a classmate who did this the entire first week. And I've heard stories that run the range from yours (having to sit down) to passing out directly on to the field. Expect to made fun of a lot if this happens to you. In the case of my classmate, however, it had no bearing at all on her grade, just her ego.

Assuming this happens more than once (which it may not), you need to figure out how to overcome it. Common things I've heard include making sure you have a decent breakfast, are well-hydrated, and (if possible) well-rested.

I have yet to hear a story about a student who never learned to cope. Most people with this problem get over it.

 

[psipsina]

Its a vagal response and its totally normal. I had one too and it wigged me out because I've never been grossed out and I thought thats what it was. People say it happens more when you are just standing there and watching instead of doing, and that it gets better with time. If you use the search function for pre-syncope/fainting or something like that there are some good threads scattered throughout the forums that give alot of ideas of ways of preventing this and what to do if it starts happening to you. Please don't stress about this though, pre-meds are far to stressed as it is 🙂

 

[braluk]

Ive done a few large animal surgeries and have shadowed several human ones, and I think the worst smell, at least in the beginning was the pool of blood in the chest cavity (smells like raw fish getting cut open), and the smell of the lightsaber (or cauterizer) cutting open flesh. It usually goes away after a week or so.

EDIT: actually the most interesting, which happened to be the worst smelling, was during an entire organ donation. We cross clamped were the last to remove an organ (the heart). Ive never seen intestines unraveled like that, nor body parts being strewn out like it was free money day. It was interesting, but had a weird sour smell to it...

 

[PugMD]

I spent a week in a L&D dept. following high risk cases and saw my fair share of c-sections and other various female proceedures. At first, the smell of the bovie was somewhat displeasing, but as the week went on I got used to it. I originally thought that the rough nature of the c-section would be the hardest to watch, but it was really much more fascinating than gut wrenching. I really wouldn't worry about your nausea compromising your medical career just yet - as with most things it seems to get easier with experience.

 

[Dr. McDreamy]

i've spent lots of time in the OR. and I've gotten lightheaded and had to sit down a few times. it usually happens halfway through the surgery in a procedure i've never seen before. usually it's procedures where I can see the whole body part they're working on (such as face, arm, leg, etc). basically, if i can see the body part and identify it, then i empathise with the patient and get sick. but if it's say, an abdominal surgery where the entire body is draped except for a little square of flesh, i dont get sick b/c it's easier to dissasociate that little square from the idea of "human body". after one time though, i'm ok for future surgeries. you'll get used to it.

but by all means, if you start feeling light headed sit down or excuse yourself. it's ok if you have to break scrub and leave....you're a med student and this reaction is only natural. that's way better than fainting on the sterile field and contaminating everything.

 

[sprinkibrio]

but its not the first time I've been around cuts, copious amounts of blood, and other sundry medical unpleasantness, even with someone I'm close to.

There's definately a difference between seeing sick people bleeding and with huge cuts than seeing someone actually cause the bleeding and cutting. There are other threads on this... search for them... they're really helpful. Try to get over this before you start your third year surgery internship if you're really interested in surgery. Go volunteer in the OR.

 

[menaniac]

Thanks sooo much for all the great posts/advice. Hearing about your experiences makes me feel a whole lot better! Not so much physically, but definately mentally🙂 . I'll look for opportunities to expose myself to the surgery scenario as much as possible to desensitize myself, and will try not to be too hard on myself as I go through the process. Thanks!

 

[oxeye]

Here's another idea that no one else has mentioned. It may have had everything to do with the fact that it was your husband and not someone relatively unknown to you.

I can watch a surgery and be fine 95% of the time. But if it is a family member, I'm on the floor 100% of the time. Something about being emotionally involved with the patient makes me VERY prone to passing out.

If you're like me, I wouldn't even worry about it unless this happens frequently while watching people you don't know. 🙂

 

[menaniac]

Here's another idea that no one else has mentioned. It may have had everything to do with the fact that it was your husband and not someone relatively unknown to you.

I can watch a surgery and be fine 95% of the time. But if it is a family member, I'm on the floor 100% of the time. Something about being emotionally involved with the patient makes me VERY prone to passing out.

If you're like me, I wouldn't even worry about it unless this happens frequently while watching people you don't know. 🙂

Someone else I know mentioned that too, so maybe I should get some experience watching non-family cutting before I pass judgement! 😉

On the other hand, when I told my mother about this whole thing (she's a surgical nurse), she said "That never happened to me! You just need more experience. Maybe your husband will have to have other tumors removed soon, and you should watch them all." I told her that my desire for more experience watching a routine excision should not cause any of us to hope that my husband has more skin cancer. She's pretty hard-core, though, and only *mostly* agreed with me...

 

[Pianoboe01]

For me, I think the issue is more doing vs. watching and also the controlled environment of an unconscious patient in the OR vs. the chaos of a screaming fully awake patient in the ER. I have tons of experience first-assisting in general surgery and in pediatric neurosurgery and have never had a problem no matter how tired/hungry I was or how long I had been standing. Yet, I've had two pre-syncopal episodes when I was just *watching* minor procedures on awake, screaming patients (a chest tube and an LP on a baby). So for me, I tend to forget it's a person under the drapes in the OR, but to see all of a fully awake, screaming patient in the ER getting a procedure makes me pre-syncopal no matter how much I try to reason myself out of it. Hopefully it will pass with time. But also with time, I will be the one doing the procedures and not just watching, which I predict will solve the problem for me.

To the OP: like others have said, I think in your case it probably had to do with watching a family member. It's different when it's somebody you know that personally. I also second the suggestion that you get as much experience in the OR as you can. I first assisted all throughout MS1 and MS2.

 

[Bertelman]

http://forums.studentdoctor.net/showthread.php?t=140546

http://forums.studentdoctor.net/showthread.php?t=214171

 

[MadameLULU]

This happened to me recently during a repair in L&D. I was gowned in one of the L&D rooms, the lights were blazing down my back and I was sooo hot. I also happened to be on my period and my knees were locked. I noticed that my vision became blurry and I started feeling lightheaded. My resident noticed that I kept saying its hot and said she looked over and my eyes were moving back and forth and had someone escort me to a chair. 😳

Apparently it happens to a lot of people, so I wouldn't worry too much about it.
I suggest eating a meal heavier on protein than carbs so it takes longer to digest. Don't lock your knees; try moving your legs in place to help circulation.

 

[vtucci]

Personally, I never had any issues with this. My problem was always over-heating in the gown + mask + face shield, but there are ways to deal with that.

The conventional wisdom seems to be that passing out your first couple times in surgery is not uncommon. When I was on surgery, I had a classmate who did this the entire first week. And I've heard stories that run the range from yours (having to sit down) to passing out directly on to the field. Expect to made fun of a lot if this happens to you. In the case of my classmate, however, it had no bearing at all on her grade, just her ego.

Assuming this happens more than once (which it may not), you need to figure out how to overcome it. Common things I've heard include making sure you have a decent breakfast, are well-hydrated, and (if possible) well-rested.

I have yet to hear a story about a student who never learned to cope. Most people with this problem get over it.

Tired- how did you deal with the heat issue?

I had bariatric surgery this past summer and get really bad reactions to heat (they think it has to do with the hypothalamus resetting my metabolic set point). I have passed out several times (or come really close) in various settings from the clinics to the offices to my classroom. It is triggered by heat, humidity (i.e., being near a neo-natal warmer) and when I wear masks, gloves etc. You said you dealt with the overheating issue. Please share your wisdom. Thanks!!

 

[Bertelman]

I also happened to be on my period and my knees were locked (prevented me from fainiting but also contributed to vaso vagal response). ...

...Don't lock your knees; try moving your legs in place to help circulation.

Forgive me, but please explain how locking your knees prevents fainting?

 

[MadameLULU]

Forgive me, but please explain how locking your knees prevents fainting?

oops. well just disregard the first sentence you quoted, k?
locked knees --> decreased muscle tension as opposed to when your knees are flexed --> decreased pumping of blood

 

[Bertelman]

oops. well just disregard the first sentence you quoted, k?
locked knees --> decreased muscle tension as opposed to when your knees are flexed --> decreased pumping of blood

We're on the same page now. That's how I understood the physiology.

 

[Tired]

I had bariatric surgery this past summer and get really bad reactions to heat (they think it has to do with the hypothalamus resetting my metabolic set point). I have passed out several times (or come really close) in various settings from the clinics to the offices to my classroom. It is triggered by heat, humidity (i.e., being near a neo-natal warmer) and when I wear masks, gloves etc. You said you dealt with the overheating issue. Please share your wisdom. Thanks!!

Sounds like you've got a few more issues than me, owing to the recent surgery and potential physiologic basis of your problems, so not sure how much this will help. But anyway, here was my experience.

After a couple cases, I started trying to identify what the specific things were that made me feel light-headed. After a while, I noticed some common things.

1) Lack of air movement - heat was less of an issue than stagnant air, especially on my face. I started tying the lower tie of my mask a little looser so that I could feel air pass over my mouth.

2) Humidity - at my institutions, there are two types of OR gowns. One seemed to have a higher "rubberized" component than the other, and hence held in moisture a lot more. I experimented with the different gowns and found one that was much more comfortable. Look around in the suppy room at the gowns and try the different types.

3) Eye shields - I had big problems with fogging with my first set of eye shields. This also exacerbated sweating by keeping humid air in the area. I found that my regular glasses were infinitely more comfortable, and I wear those in "low splash cases". In cases where I'm worried about blood splashing in my face, I wear a mask and the face shield that you tie around your forehead. This particular type of face shield has foam that holds it on your forehead. I found that cutting out some of the foam made air holes that facilitates ventillation.

4) Be nice to the circulating nurse - I try to get to the OR a little early and ask the scrub tech or circulating nurse to keep the OR a little colder. Most attendings don't seem to notice, and even if they do, oh well.

5) Sweat - my face sweats a lot when I'm working hard. If it's going to be a particularly hard case, I'm not proud, I'll wrap Kerlix around my forehead. Sure I take a little crap from the residents for it, but it's a damn site better than having to ask the nurse to wipe your forehead, or worse, dripping sweat on the field (yes, that happened to me once).

6) Weight loss - sounds stupid, but I was heavy when I started school, but by the time I got to surgery I had lost more than a couple pounds, and since then it has been much easier to tolerate being warm.

7) Experience - I think nerves had a little to do with my early difficulties. The more at ease I felt in the OR, the less I sweated and the less light-headed I got. Accept the fact that you're going to sweat a little, and accept that you will stink at the end of a long case. It's no big deal, and no one will care.

Anyway, that's what worked for me. Good luck, I think this is a problem most people work through. I have yet to meet a med student who can't go into the OR because of persistent fainting.

 

[sponch]

You can't worry about the rest of your career in one experience. Try it again, and if you have the same problems, try it again. You'll get used to the OR in no time. When I'm at the surgical field, I detach from the patient and the surgery takes on a life of its own, so I never have emotional reactions while operating. That being said, I would opt to not be in the OR if a family member were getting surgery. I wouldn't be able to help myself from back seat operating.

 

[menaniac]

Thanks so much to everyone who responded to my original post. Your suggestions/advice are very helpful! I'll keep it all in mind as I start med school in the fall!🙂 🙂 🙂